Provider Demographics
NPI:1447329545
Name:DIDOMENICO, SALVATORE DANIEL JR (DC)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:DANIEL
Last Name:DIDOMENICO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7466 EDENMORE ST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-7900
Mailing Address - Country:US
Mailing Address - Phone:727-365-4506
Mailing Address - Fax:
Practice Address - Street 1:5460 63RD ST E
Practice Address - Street 2:SUITEB
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-7808
Practice Address - Country:US
Practice Address - Phone:941-758-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55940Medicare ID - Type Unspecified